Usefulness of Hydrastis for the prevention of encrustation of long-term indwelling catheters in persons with neurogenic bladder dysfunction: a case series

Clamping Catheter Versus Free Drainage for Patients With Neurogenic Bladder With Indwelling Urinary Catheter: A Meta-Analysis

Background: In the clinical setting, individuals with neurogenic bladder dysfunction commonly utilize indwelling urinary catheters for urinary management. The comparative efficacy of catheter clamping versus continuous free drainage in this patient population is yet to be established. This meta-analysis aims to explore the efficacy and safety of catheter clamping versus natural drainage in patients with neurogenic bladder, to provide evidence to support the treatment and nursing care of these patients. Methods: Two researchers conducted a literature search in Clinicaltrials et al. databases for Randomized Controlled Trials (RCTs) comparing clamping of the catheter to free drainage in patients with neurogenic bladder who have indwelling urinary catheters. The RCT bias risk assessment tool recommended by the Cochrane Handbook was used for quality assessment. RevMan 5.3 software were used for meta-analysis. Results: A total of 8 RCTs involving 772 patients with neurogenic bladder were enrolled. Catheter clamping significantly increased the volume of first urination in patients [MD = 52.86, 95%CI (42.30, 63.41), p < .001]. The difference in time to first urination [SMD = 0.10, 95%CI (-0.68, 0.89), p = .80], residual urine volume [MD = -5.18, 95%CI (-17.27, 6.90), p = .40], incidence of urinary retention [MD = 1.07, 95%CI (0.30, 3.87), p = .92], the incidence of urinary tract infection [RR = 1.38, 95%CI (0.64, 2.97), p = .42] between the catheter clamping group and the natural drainage group were not statistically significant. The results of Egger's regression analysis indicated no evidence of statistical publication bias. Conclusion: In light of the existing body of evidence, the routine practice of catheter clamping in catheterized patients with neurogenic bladder is not recommended.

Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study

BACKGROUND

Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure.

AIM

The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI.

DESIGN

This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data.

METHODS

A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis.

RESULTS

Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'.

CONCLUSION

It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.

A New Rat Model of Sacral Cord Injury Producing a Neurogenic Bladder and Its Functional and Mechanistic Studies

Sacral spinal cord injury (SSCI) can disrupt bladder neuromodulation and impair detrusor function. Current studies provide limited information on the histologic and genetic changes associated with SSCI-related neurogenic lower urinary tract dysfunction (NLUTD), resulting in few treatment options. This study aimed to establish a simple animal model of SSCI to better understand the disease progression. Ninety 8-week-old Sprague-Dawley (SD) rats were randomly separated into sham operation and SSCI groups. The SSCI group underwent sacral spinal cord injury, while the sham group did not. Urodynamic and histological assessments were conducted at various intervals (1, 2, 3, 4, and 6 weeks) post-injury to elucidate the disease process. Urodynamic examinations revealed significant bladder dysfunction in the SSCI group compared to the sham group, stabilizing around 3-4 weeks post-injury. Histological examination, including hematoxylin-eosin and Masson's trichrome staining, correlated these functional changes with bladder microstructural alterations. RNA-seq was performed on bladder tissues from the sham group and SSCI group at 6 weeks to identify differentially expressed genes and pathways. Selected genes were further analyzed using polymerase chain reaction (PCR). The findings indicated a pronounced inflammatory response in the first 2 weeks post-SSCI, progressing to bladder fibrosis at 3-4 weeks. In conclusion, this study presents a reliable, reproducible, and straightforward SSCI model, providing insights into bladder functional and morphological alterations post-SSCI and laying the groundwork for future therapeutic research.

An in-vitro model for bacteria-related catheter encrustations

PURPOSE

About 50% of individuals with long-term indwelling catheters are affected by catheter encrustations and bladder stone formation. Therefore, prophylaxis of catheter encrustations is important. Currently, however, neither an established prophylaxis nor a standardized in-vitro model to test different measures exist. We have therefore developed and qualitatively evaluated an in-vitro model of catheter encrustation.

METHODS

Size 14 French suprapubic catheters were incubated under sterile conditions at 37 degrees Celsius in five different media: (1) sterile artificial urine (n = 16), (2) artificial urine with E. coli (n = 8), (3) with Pseudomonas aeruginosa (n = 8), (4) with Proteus mirabilis (n = 8), and (5) with a mix of these three strains (n = 8). Catheter balloons were inflated either a glycerine or a bactericidal solution. After 6 weeks, the catheters were removed from the solution, dried, and weighed, and a photometric determination of the retrieved encrustations was performed.

RESULTS

Most frequently and pronounced encrustations were detected in the Pseudomonas group. The median weight of these encrustations (50% struvite and brushite) was 84.4 mg (47.7 mg / 127.3 mg). Even on catheters stored in sterile urine, encrustations (69.2% struvite) were found. Bacterial growth was not affected by the medium used for catheter blockage.

CONCLUSION

Although in-vitro models appear to be limited because they lack "the human factor", they are valuable for systematically assessing physico-chemical factors affecting encrustations. Therefore, our model, being reliable and cost-effective, may foster further research despite its limitations.

Expression of transforming growth factor-β1 and autophagy markers in the bladder of rats with neurogenic lower urinary tract injury

OBJECTIVE

This study was conducted to explore the expression of transforming growth factor-beta 1 (TGF-β1) and its correlation with autophagy markers in the bladder of rats with neurogenic lower urinary tract dysfunction (NLUTD) post spinal cord injury (SCI).

STUDY DESIGN

A total of 36 male Wistar rats were randomly divided into the SCI group and control group. Rats in the SCI group were subjected to T10-T11 spinal cord transection. At day 1, 4, and 7, 6 rats were euthanized daily and the Basso, Beattie and Bresnahan score (BBB score), post-void residual (PVR), urinary bladder function score (UBFS) and bladder weight were assessed. The expression TGF-β1 and autophagy markers were evaluated by immunofluorescence staining, Western bolt, and qRT-PCR.

SETTING

A total of 36 male Wistar rats were randomly divided into the SCI group and control group, with three time points in each group.

PARTICIPANTS

Not applicable.

RESULTS

SCI modeling impaired the motor function of the hind limbs and the bladder function of rats. NLUTD muscle exhibited a punctated immunostaining pattern for LC3, suggesting the accumulation of autophagosomes. Our results further indicated that compared with the control group, the expression levels of TGF-β1 and LC3 were increased, while the level of P62 was decreased after SCI modeling.

CONCLUSION

TGF-β1 was significantly increased in SCI rats with NLUTD and was correlated with autophagy markers LC3 and p62.